Andragogy in PT practice

No no, not androgyny, that would be a topic for a different post :)  Androgogy refers to techniques for adult education, distinct from the term pedagogy, which refers to techniques for teaching children (although the latter is frequently used inappropriately to describe what we do in higher education).  There is little doubt that adults learn differently than do children, but for some reason we tend to hold tenaciously to the didactic lecture format in many university and college programs.  Students of post-secondary education are reasonably adaptable however, and can generally still learn through such approaches, but often complain about it in my experience.

As a certified Instructional Skills Workshop (ISW) facilitator, I get the chance to work closely with faculty who are keen to improve their classroom teaching skills.  In essence, I get to use principles of adult education to help others learn and apply principles of adult education.  It's a neat dynamic.

Yet, when I think about what I do in the clinical environment, it's clear that a good portion of my time spent interacting with clients is around education.  Whether that be teaching specific exercises, discussing pain neurophysiology, or addressing realistic expectations, I find education accounts for a considerable amount of my time in clinic.  So why shouldn't we at least develop a cursory understanding of adult education principles to help us facilitate learning in the clinical interaction?

Below I am going to outline some of the principles that I have either discovered over 10 years of university-level education, or that are used during ISW workshops for faculty, with the hope that some of us may be able to apply these to educating our clients in the clinic.

1. Relevance:  The material needs to be relevant to the individual, and clearly so.  As an adult learner, if you haven't convinced me of why I want to know pain neurophysiology, then chances are I'm not going to learn it.  This requies really understanding what your patient's goals and desires are, and may mean it will take some time to get them to the point that they are ready to receive such information.

2. Adults have short attention spans:  Do you know why television programs have commercial breaks roughly every 8 to 10 minutes?  Because that's about the limit of our attention spans for consuming the same piece of information.  A complete shift in either the type of knowledge or the mode of delivery should really occur every 8-10 minutes to keep people engaged.

3. Repetition is key:  Don't be afraid to repeat the same information, but it's a good idea to do so in different ways (ie. orally and then in a written pamphlet).  Adults will key in on items that are repeated several times, possibly because that is deemed to be the most important.  Be sure to revisit the key information from your previous session at the beginning of your next session.  This gives you one more chance to deliver important information, and to see just how much of your knowledge from last session has been retained.

4. Information should have obvious (and immediate) application:  This speaks to trimming out the fat from your educational session.  If you frequently divert off on tangents that aren't obviously applicable, then the adult learner will tend to tune out until you come back on track, and even then you may have lost them.  Keep it simple and concise and make sure the learner understands why they're learning what they're learning.  And them have them use that new knowledge somehow: either practice that new exercise or movement within an hour of leaving clinic, or have them try to explain a little about pain neurophysiology back to you or a friend or family member, depending on the content of your session.

5. Respect your client's existing knowledge:  For better or worse, students in school are often viewed as empty vessels waiting to be filled with knowledge (which is not likely the case, but that's the system we've got in North America at least).  As an adult learner, nothing bothers me more than when an educator doesn't first take the time to recognize that I've lived my own life and have gained a considerable amount of my own knowledge.  How about instead of telling me what you think I don't know, let me tell you what I already know, and you can then tell me why I'm right or wrong.

6. Understand that not everyone learns the same way you do:  there are a host of learning styles and learning style inventories out there, but I'm not suggesting we add yet another questionnaire to our poor client's.  However, it is still worth finding out from your client how they would prefer to learn: some may want you to give them some printed material to go home and mull over before coming back to chat with you about unclear points, while others will prefer you deliver the knowledge verbally and let them decide which parts are important.  Some prefer to jump in and practice, others would rather know the theory behind something first.  Understanding your client's learning preferences will allow to develop more effective educational interventions, and might explain why some people don't get it no matter how many times you've told them - they may simply learn better in some other way.

7. Make them a partner in the learning experience: think of the times when you've learned the most - chances are you were actively engaged in the learning process.  Rather than telling your patient everything they know, and thus stop them from learning, why not tell them how to find the information and allow them to learn.  Ultimately you want to facilitate knowledge 'pull' rather than 'push', the former meaning that the client wants to go out and find the knowledge, the former implies they are a passive recipient of a wall of knowledge coming at them.  Adults generally enjoy a small but achievable challenge, and this active engagement in the learning process will enhance the internalization of new knowledge.

8. Use different mediums:  The 'I talk, you listen' format that many educational sessions take might work in some instances, but eventually your client will tune out.  Consider different media or modes of delivery for your information: oral, written, video, even music or art can be useful.  Appeal to the different parts of the brain for receiving information from the environment, not only will this keep it fresh and interesting for the learner, but you're more likely to hit on something that will stick for that particular client.  Sometimes it can be as simple as changing the environment in which you deliver the information.  In one of my courses for example, I usually hold at least one class over at the grad pub on campus.  While this undoubtedly contributes to the popularity of this course, it is also one of the more interesting and active discussion sessions because at a point half way through the course, the students are ready for a change in environment.  The brain likes novel stimuli, why not provide it?

I'm aware of the irony here: this post is a perfect example of I tell, you listen.  But that's the system I'm stuck with.  Have you found other appraoches to clinical education that has worked for you?  Feel free to share in the comments section.